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5 Signs You Are in Ketosis

Dina CheneySophie Vergnaud, MD
Written by Dina Cheney | Reviewed by Sophie Vergnaud, MD
Published on February 4, 2025

Key takeaways:

  • Ketosis is a type of metabolism where your body uses fat for energy, rather than carbohydrates (glucose). 

  • Starvation can cause ketosis. So can many different medical conditions. 

  • Ketogenic diets aim to push your metabolism into ketosis to lose weight. One example of these diets is the keto diet, a high-fat, low-carb diet. But there are other ketogenic diets, such the paleo diet, the South Beach diet, and the Atkins diet. 

  • There are certain signs that your body is in ketosis, including nausea, low energy, and bad breath.

A woman touches her temple as she experiences a headache while sitting on a sofa.
urbazon/E+ via Getty Images

If you’re on a ketogenic (keto) diet, the goal is to tip your body into a type of metabolism called ketosis. That’s when your body switches from burning glucose to burning fat for energy. The idea is that eating very few carbohydrates will get you there. 

But how do you know when your body is in ketosis and burning fat instead of glucose? Read on to learn the signs that you’re in ketosis, and how to help prevent other symptoms that you may experience.  

What is ketosis?

Your body normally burns glucose for energy. Glucose comes from carbohydrates in your diet. When you restrict the amount of carbohydrates you eat, your body runs out of glucose to burn. So it turns to fat instead. Burning fat for energy generates ketones, molecules that can be used for energy. When this happens, it’s called ketosis.

Ketosis usually kicks in after your body has used up its stored glucose. Typically this happens when you eat fewer than 50 g of carbohydrates per day. The keto diet has become a popular ketogenic diet, but other diets that restrict carbohydrates, like the paleo diet, the South Beach diet, and the Atkins diet, may also be ketogenic in some cases. 

Of all of these, the keto diet is most likely to cause ketosis because it also restricts protein, another source of energy

Signs that you’re in ketosis 

When your body goes into ketosis, it may cause some side effects or symptoms. This usually occurs about 3 days into the diet

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Symptoms can be clues that you’ve reached ketosis and your body is burning fat. Keep in mind that not everyone gets symptoms. Most symptoms disappear within a few days. But a few can last longer. Here are the most common signs and symptoms of ketosis.

1. Flu symptoms

Flu-like symptoms are so common that they’ve been dubbed the “keto flu.” Flu-like symptoms tend to be much milder than an actual flu, and only last the first few days on the diet. It’s not known what causes the symptoms, but dehydration can make them worse.

Symptoms may include:

  • Upset stomach

  • Headache

  • Exhaustion 

  • Dizziness

  • Nausea

  • Fever

2. Changes to your urine

You may pee more than usual during the first week or two. Your urine may smell fruity, as soon as 12 hours after being on a keto diet. This is caused by one of the types of ketones called acetones that are produced during ketosis.

3. Bad breath

It’s very common to have bad breath when you’re in ketosis, and it may be the first thing you notice. The higher levels of acetones can cause an unpleasant fruity odor, which you may notice soon after you reach ketosis. It’s been described as smelling like nail polish remover, pear drops, or overripe fruit. Unfortunately, bad breath can last while you’re on the diet.

4. Digestive issues

Stomach issues may not be a sign of ketosis, but they can be a side effect of low-carb diets. There are a few types of issues people run into: 

  • Constipation: Nearly three quarters of people on a keto diet get constipated. Some versions of keto diets encourage low intake of grains, fruits, and vegetables. That means you’re getting less fiber, which is important for preventing constipation. The keto diet can also make you dehydrated, which can contribute to constipation.

  • Diarrhea: The keto diet also typically encourages a high fat intake. Eating a lot of fatty foods can take its toll on your digestion. If your body can’t tolerate a high-fat diet, you could develop diarrhea.

  • Abdominal pain: A high-fat, low-fiber diet may also cause gas and bloating. 

5. Weight loss

During the first 2 weeks on a ketogenic diet, it’s common to lose weight quickly. Much of this weight loss is from water. But after that, you may begin to lose fat. Your hunger may start to decrease, and you’ll likely eat fewer calories, which leads to weight loss.

How to reduce side effects and symptoms on a keto diet

Some signs and symptoms are a natural result of a ketogenic diet, but there are ways you can help ease them: 

  • To help reduce flu-like symptoms, drink about 8 cups of water daily. Staying hydrated can help ease symptoms. 

  • Try to rest and limit your activity for the first couple of days on the diet.

  • To help prevent constipation, choose low-carbohydrate fiber-rich vegetables (like asparagus and broccoli). Staying well-hydrated can also help. If you need more help, you can try a low-carb laxative, like Miralax.

  • To ease nausea, try eating more frequent small meals rather than three large meals.

  • For bad breath, try sugar-free chewing gum or mints. 

Benefits of ketosis

There are some claims that ketogenic diets may have other health benefits beyond weight loss. But the research is still limited. And there are plenty of potential risks associated with a ketogenic diet that may not outweigh the reported benefits.  

Some possible benefits may include:

  • Better cardiovascular health: There’s some evidence a keto diet could improve your levels of cholesterol and fat in your blood. 

  • Blood sugar control: There’s some evidence a low-carb diet could help people with diabetes manage their blood sugar levels. This could reduce the need for insulin and other medications. But it’s not clear whether these benefits last over time.

  • Improved cognitive skills: Some animal studies suggest the keto diet could help improve memory and attention. But the research in humans is too limited to draw any conclusions.

Potential risks

The keto diet is difficult to follow over the long term. There are risks to rapid weight loss and rebounding with weight gain. The typical keto diet tends to be high in saturated fats (often animal fats). It’s also low in carbohydrates like grains, legumes, fruits, and vegetables, which are an important source of nutrients. These dietary changes may increase the risk of certain conditions. These include: 

Certain groups may have special concerns or risks. Talk with a healthcare professional before trying a keto diet if you have any of these conditions:

  • You’re pregnant or breastfeeding.

  • You have Type 1 diabetes.

  • You have liver, kidney, or respiratory issues.

  • You’re taking the anti-seizure medication lamotrigine. The keto diet can make this medication less effective and lead to more seizures. 

Frequently asked questions

What color is pee in ketosis?

On the keto diet, your pee might darken or become more yellow because of dehydration. It’s common to be dehydrated when you enter ketosis.

Does fasting cause ketosis?

Yes, fasting causes ketosis. When you don’t eat at all, your body runs out of glucose (from carbohydrates) to burn for energy. So, it burns your fat stores instead. When your body switches from burning glucose to burning fat, it enters a metabolic state called ketosis.

What color is your poop when you are in ketosis? 

Your poop might appear greener. That’s because high-fat diets can lead to more bile, a digestive fluid. Bile is green and can change the color of your poop.

The bottom line

When you first enter ketosis, you’ll likely experience some noticeable symptoms. The most obvious symptoms are flu-like symptoms, like nausea, dizziness, and fatigue. These will go away in a few days. Other symptoms, like constipation or fruity-smelling breath or urine, could last while you’re on the diet. Lastly, you’ll likely lose weight if you’re following the keto diet.

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Dina Cheney
Written by:
Dina Cheney
I've been a professional writer for the past 25 years. As a freelance lifestyle service journalist, I've contributed articles (and recipes) to publications, including Health, Men's Health, Prevention, Good Housekeeping, Medscape, SELF, and Diabetic Living.
Laurie Tarkan
Edited by:
Laurie Tarkan
Laurie Tarkan is a senior health editor for general health and well-being at GoodRx. She has an extensive background in health journalism, and wrote regularly for The New York Times for a decade.
Sophie Vergnaud, MD
Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.
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